Provider Demographics
NPI:1659847267
Name:COBB, ELEANOR FORD (PHD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:FORD
Last Name:COBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:CLAY
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 WALKER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3523
Mailing Address - Country:US
Mailing Address - Phone:212-337-3565
Mailing Address - Fax:
Practice Address - Street 1:79 WALKER ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3523
Practice Address - Country:US
Practice Address - Phone:212-337-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty